Critical Implementation Issues Research Articles

Recent advances and current challenges of new approach methodologies in developmental and adult neurotoxicity testing.

Adult neurotoxicity (ANT) and developmental neurotoxicity (DNT) assessments aim to understand the adverse effects and underlying mechanisms of toxicants on the human nervous system. In recent years, there has been an increasing focus on the so-called new approach methodologies (NAMs). The Organization for Economic Co-operation and Development (OECD), together with European and American regulatory agencies, promote the use of validated alternative test systems, but to date, guidelines for regulatory DNT and ANT assessment rely primarily on classical animal testing. Alternative methods include both non-animal approaches and test systems on non-vertebrates (e.g., nematodes) or non-mammals (e.g., fish). Therefore, this review summarizes the recent advances of NAMs focusing on ANT and DNT and highlights the potential and current critical issues for the full implementation of these methods in the future. The status of the DNT in vitro battery (DNT IVB) is also reviewed as a first step of NAMs for the assessment of neurotoxicity in the regulatory context. Critical issues such as (i) the need for test batteries and method integration (from in silico and in vitro to in vivo alternatives, e.g., zebrafish, C. elegans) requiring interdisciplinarity to manage complexity, (ii) interlaboratory transferability, and (iii) the urgent need for method validation are discussed.

Asynchronous distributed charging protocol for plug-in electric vehicles

The proliferation of plug-in electric vehicles (PEVs) advocates a distributed paradigm for coordinating PEV charging. Unlike existing primal-dual decomposition or consensus methods, this paper proposes a cutting-plane-based distributed algorithm considering a peer-to-peer (P2P) communication network, which enables asynchronous coordination among PEVs. First, an equivalent surrogate model is established by exploiting the duality of the original optimization problem, which masks the private information of individual users by equivalent transformation. Then, a cutting-plane based algorithm is derived to solve the surrogate problem in a distributed manner with intrinsic superiority to cope with various asynchrony. Critical implementation issues, including distributed initialization, distributed cutting-plane generation, and localized stopping criteria, are discussed in detail. Numerical tests on IEEE 37- and 123-node feeders with actual data illustrate that the proposed method is resilient to several asynchronies and admits the plug-and-play operation mode. The proposed methodology is expected to provide an alternative path toward the robust protocol for PEV charging.

Understanding the behavioral intention to use urban air autonomous vehicles

In the following years, Urban Air Mobility (UAM) will transform the transport industry. Researching the intention to use air vehicles is not easy, as it is a new mode of transport that has not yet been implemented, so there are no available observed data. This fact is why the many gaps and uncertainties remain unexplored in academic research on this topic. The most critical issues for the successful implementation of a UAM transport system is public acceptance and user adoption. Based on technology adoption theories, this paper investigates critical constructs in generating usage intention to use urban air autonomous vehicles (UAAVs) and the mediator role of pro-environmental behavior and human values in this relationship. Covariance-based structural equation modeling (CB-SEM) was used with a sample from the US and China. The results confirm that attitudes, performance expectancy, and social influence reinforce the intention to use UAAVs, while anxiety reduces it. The UAAV acceptance model is very similar between the Chinese and US populations. The only difference between the two samples is that social influence has a positive and significant effect on intention to use among US people. At the same time, this variable is not essential in the Chinese sample.

The Function of Mid-day Meal Scheme: A Critical Analysis of Existing Policies and Procedures in Rayagada District of Odisha (India)

The Government of India initiated the second-largest food security programme, named the mid-day meal (MDM) Scheme to tackle nutrition-related issues, especially for children in backward communities. The main aim of the MDM Scheme in government and government-aided schools is to improve physical and economic access to nutritious food for children. The study evaluates the challenges regarding the existing practices in implementing the MDM Scheme in two blocks of the Rayagada district (Odisha, India). Rayagada district is one of the tribal districts with a high malnutrition condition among children. Further, the two blocks have been selected based on the implementation of MDM on a unique project basis in a resource crunch area. The study shows that the MDM Scheme has challenges with critical implementation issues such as delays in delivery, low-quality food, lack of water facilities and unhygienic cooking and serving practices. The findings have implications for effective implementation of the programme in similar contexts.

Positive Psychology Interventions in Medical Populations: Critical Issues in Intervention Development, Testing, and Implementation.

Positive psychological well-being is prospectively associated with superior health outcomes. Positive psychology interventions have promise as a potentially feasible and effective means of increasing well-being and health in those with medical illness, and several initial studies have shown the potential of such programs in medical populations. At the same time, numerous key issues in the existing positive psychology literature must be addressed to ensure that these interventions are optimally effective. These include (1) assessing the nature and scope of PPWB as part of intervention development and application; (2) identifying and utilizing theoretical models that can clearly outline potential mechanisms by which positive psychology interventions may affect health outcomes; (3) determining consistent, realistic targets for positive psychology interventions; (4) developing consistent approaches to the promotion of positive psychological well-being; (5) emphasizing the inclusion of diverse samples in treatment development and testing; and (6) considering implementation and scalability from the start of intervention development to ensure effective real-world application. Attention to these six domains could greatly facilitate the generation of effective, replicable, and easily adopted positive psychology programs for medical populations with the potential to have an important impact on public health.

A Pilot Study to Develop an Assessment Tool for Dogs Undergoing Trap-Neuter-Release (TNR) in Italy. An Overview on the National Implementation of TNR Programmes.

Simple SummaryThis paper describes the development of a tool to assess the welfare of dogs recruited in trap-neuter-release (TNR) programmes and the Italian situation involving the implementation of these programmes. The TNR approach has been proposed as an alternative to long-term sheltering to control the rising population of free-roaming dogs. The protocol was developed on the basis of a shelter quality protocol (SQP). The measures included in the protocol were integrated with other welfare indicators proposed in the scientific literature. Nine Italian regions out of 20 (all from central and southern Italy) prescribe by law the implementation of TNR programmes. A varied scenario and some critical issues related to the TNR approach for the management of the dog population emerged. The findings, although preliminary, suggest that the protocol could be a useful tool for the assessment of dog welfare.A descriptive analysis, inter-observer and test–retest reliability of the animal-based measures (ABMs) included in the protocol were performed. This study aimed at the development of a welfare assessment protocol for dogs recruited in the trap-neuter-release (TNR) programmes and the description of the implantation of these programmes in Italy. Nine Italian regions carried out TNR programmes. A varied scenario, along with some critical issues, emerged. Fifty dogs were recruited and assessed simultaneously by two assessors to determine the reliability of ABMs included in the protocol. A subsample of ten dogs were assessed three times to assess test–retest reliability. All females were neutered against 36% of males. Most dogs were adults (58%) and of a large size (68%). Vaccine prophylaxis and parasitic prevention were regular in 13% and 76% of dogs, respectively. Few dogs showed lameness, evidence of pain, other clinical problems, or thermal discomfort. Overall, 82% of dogs did not show fear or aggression to unfamiliar people. The level of agreement between the two assessors was quite high, ranging from substantial (0.61–0.80) to perfect (1) for the majority of measures. This study highlighted some critical issues in TNR implementation and the suitability of the protocol as a tool for animal welfare assessment.

Launch of the Norwegian Network for Implementation Research (NIMP): Proceedings from the First Annual Conference

Implementation research is growing in Norway, and the importance of implementation science for health and welfare improvements is gaining awareness across sectors. The Norwegian health and welfare systems have unique features that influence implementation research and practice, and context-specific implementation research is needed to solve Norwegian implementation issues. Implementation science has been fragmented, with limited connections between implementation researchers, disseminators, policymakers, and practitioners. Calls for a national network for implementation research echoed for several years, and in 2020 the Norwegian Network for Implementation Research (NIMP) was founded, and the first annual NIMP conference was held. With implementation science proliferating globally, similar efforts may be on the horizon in other countries. This paper describes the rationale and approach for developing NIMP, presents proceedings from the 2020 NIMP conference, and discusses the role of a national network in mobilizing implementation science communities and advancing an implementation science agenda nationally. NIMP was developed as an independent organization with six board members elected at a general assembly. NIMPs aims are to (1) raise awareness about implementation science in Norway, (2) promote sharing and exchange of knowledge from implementation research in Norway, and (3) facilitate implementation collaboration within Norway and internationally. One hundred forty-four implementation researchers, practitioners, policymakers, and students from across Norway attended the NIMP conference. There were 13 presentations of implementation research from different settings within health care, welfare services, and education. Themes included implementation strategies, barriers and facilitators, implementation theories and frameworks, and evaluation of implementation outcomes. The presentations showcased at the NIMP conference substantiated the need to connect and mobilize the implementation science community in Norway. Implementation issues are large and numerous, and more contemporary implementation research questions and designs may be required to solve them. NIMP needs to inform stakeholders in policy about the need for dedicated implementation research to improve our health and welfare systems. Critical implementation issues may require ambitious investments in implementation research. Our approach to developing a national implementation network may be of interest to aspiring networks in other countries.

From Automation System to Autonomous System: An Architecture Perspective

Autonomy is the core capability of future systems, and architecture design is one of the critical issues in system development and implementation. To discuss the architecture of autonomous systems in the future, this paper reviews the developing progress of architectures from automation systems to autonomous systems. Firstly, the autonomy and autonomous systems in different fields are summarized. The article classifies and summarizes the architecture of typical automated systems and infer three suggestions for building an autonomous system architecture: extensibility, evolvability, and collaborability. Accordingly, this paper builds an autonomous waterborne transportation system, and the architecture is composed of the object layer, cyberspace layer, cognition layer, and application layer, the proposed suggestions made in the construction of the architecture are reflected in the inter-relationships at all layers. Through the cooperation of four layers, the autonomous waterborne transportation system can autonomously complete the system functions, such as system control and transportation service. In the end, the characteristics of autonomous systems are concluded, from which the future primary research directions and the challenges of autonomous systems are provided.

Critical implementation issues of excitation signals for embedded wearable bioimpedance spectroscopy systems with limited resources

Wideband excitation signals are essential in bioimpedance spectroscopy for measurements in a time ensuring a quasi-stable measurement condition. In particular, for wearable biomedical systems, due to limited system resources, several aspects regarding measurement time, crest factor, slew rate requirements, frequency distribution, amplitude spectrum, and energy efficiency need to be thoroughly investigated. In this paper, we present an investigation of excitation signals, which includes not only the theoretical aspects but also aspects of real implementation on microcontroller-based systems. At a fixed number of samples and sampling rate, we investigate the implementability of signal frequencies and the resulting spectral efficiency. We focus on sources of signal distortion due to timer and amplitude deviations. The results show that for 4096 samples and a sampling frequency of 1 MHz, wideband signals are 2.76 times faster than a stepped frequency sweep. The multisine signal provides a better energy efficiency and has a lower slew rate requirement on hardware (around 0.3 V µs−1), but has a relatively high crest factor, even after optimization. An exemplary investigation of the distortion of the time/frequency and amplitudes following implementation on a standard industrial advanced RISC machines microcontroller has shown that a sampling rate compensation is required to overcome timer inaccuracies. Furthermore, non-return-to-zero binary signals are more sensitive to distortion due to hardware-related issues and have a lower signal-to-distortion-and-noise (SINAD) ratio than 24 dB, which is lower than the multisine signal, having a SINAD of 31 dB.

Concept mapping study of stakeholder perceptions of implementation of cognitive-behavioral social skills training on assertive community treatment teams.

This study aimed to identify factors associated with implementation of cognitive behavioral social skills training (CBSST) on assertive community treatment (ACT) teams in a large public sector behavioral health system. This study used concept mapping (a mixed-method approach) and involved a sample including diverse stakeholder participants including patients, ACT team members, team leaders, organization leaders, and system leaders. We identified 14 distinct issues related to implementing CBSST on ACT teams: (a) CBSST fit with ACT structure, (b) CBSST fit with ACT process, (c) provider perceptions about CBSST, (d) staff pressures/other demands; (e) CBSST and ACT synergy, (f) client characteristics, (g) benefits of CBSST, (h) coordination/interaction among ACT providers, (i) government/regulatory factors, (j) integration of CBSST into ACT, (k) training support, (l) training resources, (m) multilevel agency leadership, and (n) provider characteristics. Each of these dimensions were rated in regard to importance and changeability with the top 5 rated dimensions including effective training support; alignment of leadership across levels of the community-based organizations delivering services; perceived benefits of CBSST, CBSST and ACT synergy; and provider perceptions of CBSST. The most critical issues for CBSST implementation on ACT teams should be addressed in future studies. Implementation strategies that capitalize on enhancing leadership and organizational climate hold promise to address all of these issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An implementable architecture of inland autonomous waterway transportation system

Abstract Architecture design is one of the critical issues in system development and implementation. According to the characteristics and functional requirements of the inland waterway transportation system, we have visualized the application scenarios of the Autonomous Waterway Transportation System (AWTS) and constructed the architecture of inland-Autonomous Waterborne Transportation System (i-AWTS) in this paper.Autonomous Waterborne Transportation System (AWTS) comprises intelligent ships, digital transportation infrastructure, and intelligent operation organizations, has the ability of self-perceiving, self-interacting, self-learning and self-executing, and can independently coordinate to realize the function of waterway transportation system.For architecture design,first of all, the logical architecture of the i-AWTS is proposed, the system is logically layered, and the logical relationship of system function realization is designed hierarchically. Then, the organizational architecture of the i-AWTS is proposed. By designing the system information processing process and allocating system resources, the collaborative organization of information and computing, decision-making control, and application services of the system in the cloud-side, shore-side, and ship-side is realized. Finally, The physical architecture of the system is proposed, and the system functions and organizational processes are physically mapped to the relationship between the system objects. Continuous, it realizes the autonomous operation of traffic objects with different levels of autonomy in the system. The i-AWTS provides a new way of river traffic organization and explores its system architecture, which provides ideas for the system construction, organization, and implementation of the i-AWTS.

3D On-Demand Flying Mobile Communication for Millimeter-Wave Heterogeneous Networks

Millimeter wave (mmWave) technology achieving multi-gigabits speed plays a significant role in beyond 5G and the next 6G wireless communication networks thanks to its huge spectrum utilization and beam-based directional transmissions. To tackle temporary ultra-high data demands of hotspot areas, three-dimensional (3D) heterogeneous network (HetNet) is designed with the integration of mmWave unmanned aerial vehicles (UAV) to provide resilient instantaneous control and data transmissions. However, some critical beam-related issues for mmWave implementation of UAVs/drones are addressed including robust initial beam alignment, mobility-aware beam tracking and beam refinement. In this research, we aim at developing robust and efficient beam control mechanisms by implementing a prototype of 3D flying heterogeneous communications. The backhaul connections operate at mmWave frequency between airship and UAV/drone, while fronthaul links adopt lower frequency bands such as Wi-Fi for multiuser data transmissions. We evaluate system performances for our proposed beam control schemes and provide a real-time prototype of 3D on-demand flying mobile communication for mmWave HetNets.

Incorporation of Universal Prevention Curriculum into established academic degree study programme: qualitative process evaluation.

Comprehensive bachelor's, master's, and doctorate-level curricula of Addiction Studies (Addictology) were developed and implemented at Charles University (First Faculty of Medicine) between 2003 and 2012. This Prague model combines three evidence-based approaches to addressing substance use - prevention, treatment, and public health - into a balanced professionalised discipline. Graduates from this programme are licensed by the State Authority as addictology, a regulated profession in the Czech Republic. Professionals with these degrees are recognised as healthcare professionals, can perform directly in the field and can be contracted by health insurance companies. In 2016, it was decided to integrate the Universal Prevention Curriculum (UPC) into these programmes of study. The UPC was developed by a group of prevention researchers from the United States. This article describes the technical steps involved when adapting the UPC into an established university degree programme. We describe the requirements needed for successful implementation and reaccreditation. Finally, we examine both barriers and enhancers of the adoption of UPC as a university programme. A qualitative process evaluation study was conducted on the activities carried out in 2017-2018, demarcated by a successful university accreditation of the new curricula combining the original Prague model and the UPC curriculum. Field records, observation methods, official documents, curricular documents, syllabuses, content analysis, and thematic analysis were used for this process. We identified three clusters of issues and challenges during the adaptation and implementation process: technical (developing a new credit scheme, adopting new terminology using local and culture-specific examples, and cancelling, establishing, and/or fusing particular courses, identifying some critical issues for any practical implementation of the UPC); teaching staff-related (team work, involving motivated and qualified staff for moving from a national to an international perspective); and content and contextual (the conflict between different theoretical perspectives such as public health vs. mental health and drug use prevention vs. risk behaviour prevention). The adaptation of the UPC had a significant impact on study profiles and competencies. Such an implementation necessarily requires a team of staff members with sufficient capacities to be able to coordinate the process, facilitating each step and supervising it. The current adaptation of the UPC involved specific merging procedures to fit in with existing courses and emphasising an international perspective. This process opened a national discussion about the implementation of the UPC in the system of life-long education programmes and training. Beginning in September 2019, when the first group of students will attend this new model of Addictology studies, we will continue our evaluation of the implementation process and the factors that played a role in either hindering or supporting the implementation. The findings from this evaluation will be used to make adjustments to the curriculum.

On the Low-Complexity, Hardware-Friendly Tridiagonal Matrix Inversion for Correlated Massive MIMO Systems

In massive multiple-input and multiple-output (M-MIMO) systems, one of the key challenges in the implementation is the large-scale matrix inversion operation, as widely used in channel estimation, equalization, detection, and decoding procedures. Traditionally, to handle this complexity issue, several low-complexity matrix inversion approximation methods have been proposed, including the classic Cholesky decomposition and the Neumann series expansion (NSE). However, the conventional approaches failed to exploit neither the special structure of channel matrices nor the critical issues in the hardware implementation, which results in poorer throughput performance and longer processing delay. In this paper, by targeting at the correlated M-MIMO systems, we propose a modified NSE based on tridiagonal matrix inversion approximation (TMA) to accommodate the complexity as well as the performance issue in the conventional hardware implementation, and analyze the corresponding approximation errors. Meanwhile, we investigate the very-large-scale integration implementation for the proposed detection algorithm based on a Xilinx Virtex-7 XC7VX690T FPGA platform. It is shown that for correlated massive MIMO systems, it can achieve near minimum mean square error performance and 630 Mb/s throughput. Compared with other benchmark systems, the proposed pipelined TMA detector can get high throughput-to-hardware ratio. Finally, we also propose a fast iteration structure for further research.

Design, implementation, and analysis considerations for cluster-randomized trials in infection control and hospital epidemiology: A systematic review.

In cluster-randomized trials (CRT), groups rather than individuals are randomized to interventions. The aim of this study was to present critical design, implementation, and analysis issues to consider when planning a CRT in the healthcare setting and to synthesize characteristics of published CRT in the field of healthcare epidemiology. A systematic review was conducted to identify CRT with infection control outcomes. We identified the following 7 epidemiological principles: (1) identify design type and justify the use of CRT; (2) account for clustering when estimating sample size and report intraclass correlation coefficient (ICC)/coefficient of variation (CV); (3) obtain consent; (4) define level of inference; (5) consider matching and/or stratification; (6) minimize bias and/or contamination; and (7) account for clustering in the analysis. Among 44 included studies, the most common design was CRT with crossover (n = 15, 34%), followed by parallel CRT (n = 11, 25%) and stratified CRT (n = 7, 16%). Moreover, 22 studies (50%) offered justification for their use of CRT, and 20 studies (45%) demonstrated that they accounted for clustering at the design phase. Only 15 studies (34%) reported the ICC, CV, or design effect. Also, 15 studies (34%) obtained waivers of consent, and 7 (16%) sought consent at the cluster level. Only 17 studies (39%) matched or stratified at randomization, and 10 studies (23%) did not report efforts to mitigate bias and/or contamination. Finally, 29 studies (88%) accounted for clustering in their analyses. We must continue to improve the design and reporting of CRT to better evaluate the effectiveness of infection control interventions in the healthcare setting.

How is implementation research applied to advance health in low-income and middle-income countries?

This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health...

Developing a causal model to evaluate the critical issues in reverse supply chain implementation

PurposeApproximately, 800m tons of e-waste is generated per year in India. Reverse supply chain (RSC) is the probable strategy to cope up with the issue. Setting up a RSC process is not popular in the Indian sector. There are several factors that basically control the profitability of such kind of business. Hence, the purpose of this paper is to develop a causal model among the identified issues and sub-issues for setting up a RSC in an Indian semiconductor manufacturing industry and then evaluate the critical issues based on the causal relations.Design/methodology/approachDecision-making trial and evaluation laboratory (DEMATEL) method along fuzzy set theory is used to develop the causal framework among the identified strategical and tactical issues. According to the causal relations from DEMATEL, analytical network process is then used to identify the weights of the sub-issues.FindingsThe cause–effect interactions among the main issues show that legislations and regulations, market-related issues and organizational issue are the most significant strategic issues. Uncertainty in the acquisition time is the most significant tactical issue because it has a crucial impact on the quality and quantity of the used products. Based on the obtained causal relations of the main issues, it is identified that the reduction of waste, creation of new opportunity, market competition, cost reduction, change in technology and location, capacity and number of recovery facility are the major sub-issues in RSC implementation.Practical implicationsThis study is conducted on the basis of the experts’ opinion from a semiconductor manufacturing industry, situated in the southern part of India. Therefore, this proves its practical implications.Originality/valueThe paper provides the detail illustration of the issues in the RSC process, and the prioritization of the issues based on the cause–effect relationships also provides some meaningful managerial insights.

Strategic performance management system in uncertain business environment

PurposeBusiness performance management describes the processes, methodologies, metrics and systems needed to measure and manage the performance of an enterprise. Traditional performance management systems were based on financial and productivity measures but the alternate measures proposed in last more 25 years have strategic focus and incorporate variety of performance measures such as efficiency, effectiveness, productivity, quality, customer satisfaction, innovation and employee satisfaction in addition to financial. Globalization and modernization have created a business environment uncertain with associated risks which has necessitated the incorporation of various types of flexibilities such as strategic, technical, operational, information system (IS), etc. Critical success factors and implementation issues also need to be incorporated to succeed. The purpose of this paper is to present the strategic performance management system (SPMS) designed, incorporating flexibility and implementation issues, and its effectiveness empirically validated from Indian oil industry.Design/methodology/approachBased on literature review and gaps identified, a proposed model of enterprise performance management system incorporating flexibility, critical success factors and implementation issues was developed. Macro- and micro-level factors impacting the effectiveness of the model were identified, and hypotheses were developed and tested empirically from the survey study of Indian oil industry.FindingsThe finding met, by and large, most of the research objectives. In total, 7 macro- and 11 micro-level factors came out from the study. The strategy planning, strategy implementation, strategic flexibility (SF), SPMS design, information system flexibility (IF) flexibility, implementation issues and critical success factors, and performance feedback and learning are the macro-level factors impacting the SPMS effectiveness in measuring and managing performance of an enterprise. The SPMS implementation issues have proved to be major driver of effectiveness.Research limitations/implicationsThe research like many such researches had limited resources, data availability and bias of respondents. However, the model was statistically validated for its reliability and hypothesis testing. The research has added to literature on SPMS as integrated model incorporated SF, information flexibility and critical success factors. However, the effect of other types of flexibilities such as organizational, operational, HR, marketing, etc., and other stakeholders should also be studied in future research to broaden the findings.Practical implicationsThe validated SPMS has practical implications for academics and researchers. Strategic and IF, and critical success factors have been incorporated in the integrated model to take care of business uncertainties so that it is strategically aligned and facilitate in effective SPMS use and implementation.Social implicationsThough it has no direct social implication but, if adopted for social projects and not-for-profit organizations, it will have social benefits of efficient and effectiveness delivery of social projects and initiatives.Originality/valueThis is an original work carried out by the authors. The validated model along with interpretation is presented.

A Synergistic Approach to Robust Output Feedback Control: Tube-based Multi-stage NMPC

Plant-model mismatch and estimation errors are critical issues in the practical implementation of Nonlinear Model Predictive Control (NMPC). To address these challenges, we formulate a robust output feedback NMPC scheme that is real-time implementable and provides robust constraint satisfaction in the presence of parametric and additive uncertainties, and estimation errors. The robustness is achieved by combining the tube-based and the multi-stage NMPC approaches. Two controllers are used in the proposed framework: a primary controller with tightened constraints that optimizes a given objective and an ancillary controller that tracks the trajectories provided by the primary controller. Unlike standard tube-based NMPC, the primary controller predicts different state trajectories for different realizations of the most important uncertainties using the multi-stage NMPC framework. The synergy between the two approaches leads to a better trade-off between optimality and complexity. The advantages of the proposed approach are demonstrated for an industrial-scale fed-batch polymerization reactor example.

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

ABSTRACTPurpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions.The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact.Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.